Real-World Use of Prolaris® to Guide Treatment Decisions in Localized Prostate Cancer Eligible for Active Surveillance

Introduction: Active surveillance (AS) is the guideline-recommended management strategy for low-risk and favorable intermediate-risk prostate cancer (PCa). However, conventional risk stratification remains limited in predictive accuracy. Robust real-world evidence on the clinical utility of the cell cycle risk (CCR; Prolaris®) score within European healthcare settings is currently scarce. Methods: We performed a retrospective single-center study of 60 localized PCa patients who underwent CCR testing at a tertiary academic urologic center between 2021 and 2025. We analyzed indications for testing, CCR treatment recommendations, and adherence rates using descriptive statistics. Results: Median patient age was 62 years, and median prostate-specific antigen level was 5.76 ng/mL. Overall, 13.3% of biopsy cores were positive, and 93.3% of patients had a Gleason score of 6. CCR testing was performed after initial diagnosis in 61.7% of patients and during ongoing AS in 38.3%. Following CCR testing, definitive therapy was recommended in 21.7% of patients, with an adherence rate of 53.8%, whereas continued AS was recommended in 78.3% of patients, with an adherence rate of 87.2%. Conclusion: CCR testing demonstrated high adherence rates, particularly for AS recommendations in the real-world setting. These findings support Prolaris® as a complementary decision aid for AS patient selection and management.